Sellner J, Lüthi N, Schüpbach W M M, Gebhardt A, Findling O, Schroth G, Mattle H P, Nedeltchev K
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Spinal Cord. 2009 Apr;47(4):312-7. doi: 10.1038/sc.2008.143. Epub 2008 Nov 18.
Retrospective 9-year survey.
Clinical presentation of acute myelitis syndromes is variable, and neuroimaging and laboratory findings are not specific enough to establish the diagnosis with certainty. We evaluated the spectrum clinical features and paraclinical findings encountered during diagnostic workup and aiding the diagnosis.
Department of Neurology, Inselspital Bern, Switzerland.
Charts and magnetic resonance imaging (MRI) of 63 patients discharged with the diagnosis of acute transverse myelitis.
The diagnosis was supported by abnormal MRI and cerebrospinal fluid (CSF) findings in 52 patients (82.5%) and suspected in the remaining either because of a spinal cord MRI lesion suggestive of myelitis (n=5), or abnormal CSF findings (n=4), or electrophysiological evidence of a spinal cord dysfunction (n=2). Clinical impairment was mild (ASIA D) in the majority. All patients had sensory disturbances, whereas motor deficit and autonomic dysfunction were less frequent. Neurological levels were mainly located in cervical or thoracic dermatomes. Spinal cord lesions were visualized by MRI in 90.4% of the patients and distributed either in the cervical or thoracic cord, or both. Multiple lesions were present in more than half of the patients, and lateral, centromedullary and posterior locations were most common. A high percentage of multiple sclerosis (MS)-typical brain lesions and CSF findings suggested a substantial number of MS-related myelitis in our cohort.
The diagnostic workup of acute myelitis discloses a broad spectrum of CSF or MRI findings, and may be associated with diagnostic uncertainty due to lack of specific CSF or MRI features, or pathological findings.
9年回顾性调查。
急性脊髓炎综合征的临床表现多样，神经影像学和实验室检查结果不足以确诊。我们评估了诊断检查过程中遇到的一系列临床特征和辅助检查结果，以辅助诊断。
瑞士伯尔尼因塞尔医院神经内科。
63例诊断为急性横贯性脊髓炎出院患者的病历和磁共振成像（MRI）资料。
52例患者（82.5%）的诊断得到了MRI异常和脑脊液（CSF）检查结果的支持，其余患者因脊髓MRI病变提示脊髓炎（n=5）、脑脊液检查结果异常（n=4）或脊髓功能障碍的电生理证据（n=2）而被怀疑患有该病。大多数患者的临床损伤较轻（ASIA D级）。所有患者均有感觉障碍，而运动障碍和自主神经功能障碍较少见。神经平面主要位于颈段或胸段皮节。90.4%的患者通过MRI观察到脊髓病变，病变分布于颈段或胸段脊髓，或两者均有。超过一半的患者存在多发病变，最常见的病变部位是外侧、中央髓质和后部。高比例的多发性硬化（MS）典型脑病变和脑脊液检查结果提示我们的队列中有大量与MS相关的脊髓炎。
急性脊髓炎的诊断检查显示出广泛的脑脊液或MRI检查结果，并且由于缺乏特异性的脑脊液或MRI特征或病理检查结果，可能存在诊断不确定性。
